Some Blood Pressure Drugs Raised Pancreatic Cancer Risk in Women

Alan Mozes wrote . . . . . . .

Certain drugs prescribed to treat high blood pressure may boost a woman’s risk for developing pancreatic cancer after menopause, new research suggests.

In a large study of postmenopausal women, those who had ever taken a short-acting calcium channel blocker (CCB) saw their pancreatic cancer risk shoot up by 66 percent.

And women who had used a short-acting CCB for three years or more faced more than double the risk for pancreatic cancer, compared with those who had taken other types of blood pressure drugs.

This class of drugs includes short-acting nifedipine (brand names Procardia, Adalat CC); nicardipine (Cardene IV); and diltiazem (Cardizem).

The short-acting CCBs were the only blood pressure drugs linked to higher pancreatic cancer risk, according to study lead author Zhensheng Wang.

However, people taking this class of drugs shouldn’t panic, because their absolute risk of developing pancreatic cancer still remains very low. According to the U.S. National Cancer Institute, just 1.6 percent of Americans will develop the cancer during their lifetime. That means that — even after accounting for a bump up in risk from taking a CCB — an individual’s odds for the disease remains minimal.

Still, the new finding was unexpected, said Wang, a postdoctoral associate at Baylor College of Medicine in Houston.

Prior investigations had hinted that CCBs might even protect against pancreatic cancer by boosting levels of a protein (sRAGE) known to keep inflammation in check, said Wang.

Reduced inflammation is typically associated with a lower risk for a range of cancers.

So what might explain the current results?

Wang noted that short-acting CCBs are “the least effective” blood pressure drug available. That could mean many of the women in the study had not achieved good blood pressure control to begin with, which could have boosted their risk for diabetes. And diabetes is a known risk factor for pancreatic cancer.

Wang also said blood samples taken from more than half the pancreatic cancer patients revealed that those who had ever taken a short-acting CCB also had notably lower levels of the sRAGE protein, compared with women who had taken other types of blood pressure drugs. That would mean less inflammation control and, therefore, potentially higher cancer risk.

Finally, he hypothesized that women who are prescribed short-acting CCBs might differ in some way from patients prescribed other types of blood pressure control.

CCBs tamp down blood pressure by preventing calcium from entering cells in the heart and blood vessel walls, thereby decreasing cardiac stress and workload.

In 1996, the U.S. Food and Drug Administration took steps to discourage doctors from prescribing short-acting nifedipine. It warned that some researchers had linked the drug to an increased risk for heart attack and stroke.

The current study followed more than 145,000 participants in the Women’s Health Initiative study. They were between 50 and 79 years old at the start of the study, and medication use — but not dosage — was monitored between 1993 and 1998.

By 2014, more than 800 had developed pancreatic cancer, with risk up only among those who had been prescribed a short-acting CCB, Wang’s team found.

For those who’d used the drugs three years or more, risk of pancreatic cancer was 107 percent higher than for those who took other blood pressure drugs.

Longer-acting CCB drugs were not associated with any risk elevation. Neither were beta blockers, diuretic drugs or ACE inhibitors.

Wang and his colleagues plan to present their findings this week at a meeting of the American Association for Cancer Research in Chicago.

He said the findings need to be reconfirmed. Also, research presented at meetings is usually considered preliminary until peer-reviewed for publication in a medical journal.

One cancer specialist agreed that more investigation is warranted.

“There is no doubt more research needs to be done on this,” said Dr. Victoria Rutson, chief medical officer for the Pancreatic Cancer Action Network in Manhattan Beach, Calif.

But for now, Rutson advised patients to “consult with their doctors before removing or adding any medications.”

“Removing hypertension medications can be extremely dangerous, especially if someone has a history of high blood pressure,” she warned.

Rutson also said if pancreatic cancer runs in your family, you might want to consult a doctor.

“If you have a familial history of pancreatic cancer, it is important to visit with a gastroenterologist, especially if you begin to exhibit any symptoms that are new or out of the ordinary,” Rutson added.

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. Wang said it typically strikes older adults with chronic medical conditions, such as high blood pressure.

Source: HealthDay


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Babies Given Antacids or Antibiotics May Have Higher Odds for Allergies Later

Alan Mozes wrote . . . . . . . . .

Babies who are given antacids or antibiotics during their first 6 months of life may have a sharply higher risk for allergies or asthma, a large new study warns.

The finding is based on an analysis of health records of more than 792,000 children born between 2001 and 2013.

While the study does not prove that the medications cause allergy, lead author Dr. Edward Mitre said the links appear to be strong.

“I did find it striking that we found positive associations between the use of antacid medications and virtually every class of allergy we evaluated,” he said. That associated risk “appears substantial and clinically significant,” Mitre added.

Infant antacid exposure was linked to a doubling of the risk for developing food allergies, and a 50 percent increase in the risk for developing drug allergies and a hypersensitive immune reaction to foreign toxins, such as a bee sting (anaphylaxis).

Exposure to antibiotics appeared to double children’s future asthma risk, while prompting a 50 percent increase in risk for allergies to dust, dander and pollen (allergic rhinitis); eye allergies (allergic conjunctivitis); and anaphylaxis, Mitre said.

But why?

Mitre suspects “biological reasons” are at play.

“Both antibiotics and antacid medications can disturb the normal microbiome,” he said, referring to the complex environment of microbes that is critical to a well-functioning immune system. Evidence is mounting that changes in the microbiome can increase allergy risk.

Antacids can reduce protein digestion in the stomach, Mitre explained, which may lead to food allergies.

Mitre is an associate professor of microbiology and immunology at the Uniformed Services University (USU) of the Health Sciences’ School of Medicine in Bethesda, Md.

Mitre and his colleagues published their report online in JAMA Pediatrics.

Co-author Dr. Cade Nylund said that while babies are prone to acid reflux, it’s typically not a cause for concern or drug treatment.

“One reason that infants are prone to reflux is the immature anatomy of the infant,” he noted. “Another is they have to eat so many calories per body weight. If an adult were to have to take in the same volume as an infant, it would be like drinking roughly two quarts every four hours. If I did that, I would be spitting up, too.”

Nyland said that, in most cases, feeding babies smaller and more frequent meals and burping them often is preferable to giving them antacids.

He is an associate professor of pediatrics at USU, and program director of the pediatric gastroenterology, hepatology and nutrition fellowship at Bethesda’s National Capital Consortium.

Added Mitre: “There are certainly some infants with severe gastroesophageal reflux who warrant medical therapy, but it is probable that the vast majority do not.”

Still, the team found that about 8 percent of the children in their analysis had been prescribed an antacid during their first six months of life.

All were enrolled in the military health system within 35 days of birth and stayed enrolled for at least a year. Investigators looked at their early medication exposure and the onset of allergies and asthma over an average period of 4.6 years.

The study findings underscore well-known risks of antibiotics and counter the belief that acid-suppressives are harmless, Mitre said.

“Given the association we and others have found between acid-suppressive medications and allergy, and given that they are not generally beneficial for infants, this study suggests that antibiotics and acid-suppressive medications should only be used in situations of clear clinical benefit,” Mitre concluded.

Source: HealthDay


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Some Drugs Older Adults should Avoid

Patricia Corrigan wrote . . . . . . . .

You fill a prescription, a medication you’ve relied on before. A few days later, you experience a troubling side effect. You read online that no one your age should take this medication.

What happened?

Drug Side Effects and Older Adults

Two pharmacists say the aging process is to blame, and they reveal here the names of medications on their “black list” that older adults may want to avoid.

“Prescribing medications for people 65 and older can be more challenging, because some drugs can be more toxic or cause more side effects than when you were younger,” says Kirby Lee, a pharmacist and associate professor of clinical pharmacy at the University of California at San Francisco. “As your body ages, it absorbs medications differently. They can be metabolized differently by your liver and excreted differently by your kidneys, so you may be more sensitive to some medications.”

That’s what happened to me.

Antibiotic Causes Painful Achilles

One recent weekend, I experienced a relapse while on doxycycline, an antibiotic prescribed for a bacterial sinus infection. The doctor on call I spoke with prescribed a stronger antibiotic for me, levofloxacin (Levaquin), one I’d taken successfully a decade ago.

After four days on the new drug, a throbbing Achilles tendon awakened me in the wee hours. I hobbled to the computer and learned the drug is not recommended for people 60 and older. I am 68. Later that morning, I called my internist, who advised me to stop taking it and start helping the tendon to heal — no easy task, and one with no quick fix.

Our aging bodies are not the only challenge. Only about 7,500 physicians in the U.S. specialize in the care of older adults, according to the American Geriatrics Society. With 46 million Americans age 65 and older today, that works out to about one geriatrician per 6,100 patients.

That’s obviously not enough geriatricians now — and by 2060, some 98 million Americans will be 65 and over.

“Until you enter a nursing home or assisted living, you might not see a specialist good at treating older adults, because we don’t yet have a health care system designed to take care of older adults,” says Chad Worz. He is a consultant pharmacist with Medication Managers in Cincinnati and president-elect of the American Society of Consultant Pharmacists (ASCP).

More Assistance from Pharmacists

Based in Alexandria, Va., and with more than 9,000 members, ASCP is said to be the only international professional society devoted to “optimal medication management and improved health outcomes” for older people. Consultant pharmacists work in adult day centers, assisted living facilities, community pharmacies, hospice programs, home care programs, mental health facilities, nursing homes, pharmaceutical companies, physicians’ offices and rehab centers.

On the job, ASCP members evaluate individuals’ medication lists to determine which drugs can be dropped. “In that regard, I am an anti-pharmacist,” Worz says, laughing.

“Every day I look at the records for people on 14 or 15 medications and try to get them to eight or nine. Instead of stopping a drug that causes a certain side effect, doctors often prescribe a drug to fix the side effect,” he says. “I don’t blame the doctors. I blame the system, which does not incentivize patients to have sit-down conversations with doctors or pharmacists about medications.”

Medications You May Want to Avoid

Here are six classes of medications considered especially problematic for older adults:

  • Benzodiazepines Prescribed — often over-prescribed — for anxiety and sleep disorders, this class of drugs includes diazepam (Valium), lorazepam (Ativan), alpraxolam (Xanax) and chlordiazepoxide (Librium). The medications can cause confusion and greatly increase the risk of falling.
  • Non-Benzodiazepines Prescribed for insomnia, Zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) are highly addictive and also can cause bizarre sleep behaviors, including sleepwalking.
  • Anticholinergics Diphenhydramine (Benadryl), acetaminophen with diphenhydramine (Tylenol PM) and some muscle relaxants that contain diphenhydramine (an antihistamine) can cause confusion, constipation, dry mouth, blurry vision or urine retention in older adults. Cumulative exposure to these drugs can lead to dementia.
  • Nonsteroidal anti-inflammatory drugs Ibuprofen (Motrin), naproxen (Aleve), aspirin and other drugs in this class are “tough on kidneys,” Lee says, and increase the possibility of stomach bleeds. They are not recommended for long-term use. For management of arthritis pain, Lee recommends acetaminophen (Tylenol), physical therapy, acupuncture, aquatic therapy or acupressure.
  • Antipsychotics This class of drugs is useful to treat significant psychosis or serious mental health conditions, but is too often prescribed for mild agitation, anxiety or depression. Lee suggests taking the lowest effective dose for the shortest term possible. “People get started on these and then they don’t top,” he says.
  • Old drugs Though barbiturates are rarely prescribed any longer, these sedatives are still available and are highly addictive both physically and psychologically.

Worz notes that blood pressure medications also can cause fatigue or lead to falls.

And he suggests being cautious with the dosage for ranitidine (Zantac), often taken for heartburn. “Taking 150mg twice daily is a normal dose, but in an older person, kidney function may no longer be sufficient to eliminate the drug quickly.” That can lead to possible cognitive issues that can look like dementia.

“Nobody should have to live with a problem that is the result of taking a drug,” Worz adds. “Your doctor or pharmacist usually can find better drugs with fewer side effects to help you.”

For information about other medications that may cause problems for older adults, Worz recommends the “Beers List,” named for the physician who first published the list, , which is updated periodically by the American Geriatrics Society.

Why That List of Side Effects Is Important

And what about that antibiotic that caused me so much trouble?

Worz notes that other antibiotics in the same class have been pulled from the market after causing changes in the nervous system, hallucinations and other problems. “Still, it’s impossible to predict exactly how a medication may affect someone, and even a lengthy list of potential side effects may not be specific enough,” he adds.

I can’t be angry with the physician who neglected to take my age into consideration, because I share in the blame.

When I picked up the prescription, I waved off a consultation with the pharmacist, saying I’d taken this antibiotic before. Then, after reading just a sentence or two of the lengthy list provided to me of possible side effects, I tossed the paper into a recycling bin.

That is one of two typical responses, Lee says. “I’ve seen people blow it off — or get so scared they won’t take anything. The information on side effects is based on factual data and written for legal purposes, but it will help you sort out common and less-common side effects, learn what side effects are considered severe and be aware of contraindications.”

Once you read the material, Lee adds, you can weigh the side effects against the benefits of taking the medication. “You also can ask the pharmacist or your doctor what taking the medication might mean for you, and what alternatives there are,” he notes.

Don’t Keep Secrets from Your Doctor

Lee stresses the importance of providing your doctor with an updated list of everything you take, including prescribed medications, over-the-counter drugs and dietary supplements. Also, alert your doctor about any drug allergies or bad reactions to medications you’ve had.

As always, talk to your doctor before you stop taking any prescribed medications. And, remember: no one bit of advice fits all.

“Keep in mind that complications from medications are general trends due to body changes by the time you are 65 or 70,” Lee says. “Some people are likely to experience these complications, but others may have a body that functions like that of a 35-year-old. Always look at your metrics and go from there.”

Source : NextAvenue


Read also at University of Minnesota:

Research Brief: Older adults often prescribed meds linked to higher side effect risks . . . . .


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Medicare Claims Show Long-term Prostate Cancer Prevention Benefits of the Medication Finasteride

Men who take the medication finasteride get a prostate cancer prevention benefit that can last 16 years – twice as long as previously recorded, according to SWOG clinical trial analysis published in the Journal of the National Cancer Institute.

This finding was made possible by a new research strategy – linking Medicare claims data to clinical trial data, in this case from a landmark study run by SWOG, the federally funded cancer clinical trial network. The SWOG study, known as the Prostate Cancer Prevention Trial, or PCPT, set out to see whether finasteride, a drug used to treat symptoms of prostate enlargement as well as male pattern baldness, would prevent prostate cancer in men over the age of 55. The study enrolled 18,882 men from 1993-1997. It was stopped in 2003 when investigators learned that finasteride reduced prostate cancer risk by 25 percent when compared with a placebo. SWOG leader Ian Thompson, Jr., MD, of CHRISTUS Santa Rosa Hospital Health System, was the study chair of PCPT.

Joseph Unger, PhD, a SWOG biostatistician and health services researcher from Fred Hutchinson Cancer Research Center, has a track record of using new research methods to answer bigger, bolder questions about cancer prevention and treatment. Along with SWOG colleague Dr. Dawn Hershman, Unger has pioneered for a decade the use of secondary sources of data, such as Medicare claims, U.S. Census Bureau data, and public health statistics from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, to examine new hypotheses.

For this study, Unger wanted to know if the protective effects of finasteride lasted longer than seven years – the amount of follow-up evaluated in the PCPT. Answering this question would typically require reopening the old study, reconnecting with patients, and conducting extensive follow-up – an expensive and time-consuming proposition. But Unger took another tack, requesting and obtaining a data use agreement from the federal Centers for Medicare & Medicaid Services to access to records from Medicare, the health insurance program for people over 65.

Using patient information from the PCPT, Unger linked patients enrolled in the PCPT to their Medicare claims from 1999 through 2011. The team was surprised to find they were able to successfully link 75 percent of PCPT trial participants. Unger and colleagues at Fred Hutch created an algorithm to flag a prostate cancer diagnosis in the Medicare data, and examined the diagnoses over time. The team identified 3,244 PCPT participants who were later diagnosed with prostate cancer over a median follow-up of 16 years, and found that participants on the PCPT that took finasteride had a 21 percent decreased risk of getting prostate cancer, compared to those who took a placebo drug, over the course of those 16 years.

“These findings raise the intriguing possibility that seven years of finasteride can reduce prostate cancer diagnoses over a much longer period than was previously shown,” Unger said. “It’s a low-cost generic drug, with minimal side effects, that can have a benefit that lasts long after men stop taking it.”

At the same time, Unger said, the SWOG study shows the value of using Medicare claims to extend follow-up for trial participants and answer new questions about cancer care and prevention. “These secondary data sources are emerging as a new paradigm for long-term follow up for cancer clinical trials,” he said. “It’s an exciting new avenue of research.”

Source: SWOG


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Three Medications in One “Triple Pill” Helps Control High Blood Pressure

A pill that combines three blood pressure-lowering drugs improves people’s chances of lowering their high blood pressure, researchers report.

The pill contains low doses of the three medications — telmisartan, amlodipine and chlorthalidone.

The finding stems from a study of 700 people, who averaged 56 years old. All had high blood pressure.

Among those who took the so-called “triple pill” for six months, 70 percent had achieved their blood pressure targets, compared with 55 percent of those who received their usual care. Usual care meant taking whatever blood pressure medicine their doctor prescribed.

The rate of side effects was no greater among those who took the three-in-one pill than among the usual care group.

“Based on our findings, we conclude that this new method of using blood pressure-lowering drugs was more effective and just as safe as current approaches,” lead author Ruth Webster said in a news release from the American College of Cardiology. She’s a researcher with the George Institute for Global Health at the University of New South Wales in Sydney, Australia.

The study was presented Monday at the annual meeting of the American College of Cardiology in Orlando, Fla. The findings should be considered preliminary because research presented at meetings has not undergone the rigorous scrutiny given to research published in medical journals.

“The most urgent need for innovative strategies to control blood pressure is in low- and middle-income countries,” Webster said. “The triple pill approach is an opportunity to ‘leapfrog’ over traditional approaches to care and adopt an innovative approach that has been shown to be effective.”

High blood pressure increases the risk for heart attack, stroke and kidney problems.

“A control rate of 70 percent would be a considerable improvement, even in high-income settings,” Webster said. “Most hypertension guidelines in these countries do not recommend combination blood-pressure-lowering therapy for initial treatment in all people.”

The findings, she said, “should prompt reconsideration of recommendations around the use of combination therapy.”

Source: HealthDay


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